Surgical Strategies in Renal Cancer: A Meta-analysis of Partial vs. Radical Nephrectomy Outcomes Across Tumor Stages

Abstract

Background: Surgical intervention remains the primary treatment for localized renal tumors and masses, with partial nephrectomy (PN) and radical nephrectomy (RN) being the two most frequently employed procedures. The choice between these approaches is often influenced by factors such as tumor size, location, histology, and patient comorbidities. However, the decision between PN and RN remains a subject of ongoing debate, particularly as emerging evidence suggests varying outcomes based on the stage and type of renal tumors. This meta-analysis evaluates the association between renal tumor stage and subtype with the outcomes of PN and RN, focusing on renal function, cancer-specific survival, and postoperative complications.

Method: An exhaustive search was conducted across PubMed, Scopus, and Embase databases, covering the literature from their inception up to March 2023, in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Original studies comparing PN to RN in the management of renal tumors at various stages were meticulously screened, adhering to stringent inclusion and exclusion criteria. This protocol was registered on PROSPERO (CRD42023455985).

Result: Overall, 38 cohort studies were included, with a total of 144,608 patients diagnosed with renal cancer who underwent nephrectomy, 71,582 who underwent PN, and 72,671 who underwent RN. The data revealed a significant difference in cancer-specific survival between PN and RN, which was higher in the RN group (pooled HR: 1.17; 95% CI = 1.01–1.35) p < 0.001. The postoperative renal function of patients who underwent RN was worse than that of patients who underwent PN (pooled RR: 4.22; 95% CI: 1.45, 12.27, p < 0.00001). The relative risk of papillary renal cell carcinoma (RCC) was lower in patients who underwent RN as compared to PN (the pooled RR, 1.32; 95% CI = 1.02, 1.72, p < 0.001), while the relative risk of RCC collecting duct subtype was significantly lower patients who underwent PN as compared to RN (the pooled RR, 0.44 (95% CI = 0.29, 0.67) p = 0.97. Additionally, the pooled risk for patients with a Charlson Comorbidity Index score of ≥2 was lower in the PN group compared to the RN group.

Conclusion: Across various tumor stages, RN demonstrates superior cancer-specific survival, and a lower incidence of postoperative complications compared to PN. However, PN is associated with more favorable renal function preservation. These findings, in conjunction with individual patient characteristics, should be meticulously evaluated to inform the selection of the most appropriate surgical approach and guide patient counseling.